chicory root whitepaper · 2019-06-08 · chicory root fiber a proven prebiotic. chicory is a...

Chicory root fibers – supporting a healthy gut microbiota and beyond.

prebiotic

fiber

3

Your microbes at work to keep your gut f lora healthy. 4

The prebiotic concept: more relevant than ever. 4

Chicory root fiber – a proven prebiotic. 6

The prebiotic effect – bifidos as a marker for a healthy microbiota. 7

Microbiota, digestive health and well-being – health benef its linked to chicory root f iber. 8

Prebiotic fermentation: “To the gut and beyond!” 8

Digestive health, a key predictor of well-being. 10

What about FODMAP in IBS patients? 12

Feeling the digestion is OK! 13

Chicory root fiber influences the path towards a healthy body weight. 13

Bringing your blood sugar under control. 16

For stronger bones: Give your bones a treat. 16

What about the little ones? Benef its of chicory root f iber intake in infants and small children. 18

Importance of early colonization. 18

Healthy bowel habit, more important than ever. 20

Increased inner protection. 21

Concluding remarks 22

References 24

Content

4

Your microbes at work to keep your gut flora healthy.

We are never alone. A vast number of microbes live within us, making up the human microbiota. In recent

years, a growing number of research studies have focused on the link between these microbes and our health.

It became clear that the role of our gut microbiota has reached importance far beyond gut health. Several

factors can influence the balance of the gut microbiota. Prebiotics are among them and their beneficial

effects will be discussed here.

The prebiotic concept: more relevant than ever.

The composition of the gut microbiota can be influenced by specific dietary components available for bacterial

break down. The prebiotic concept describes food constituents that feed the good bacteria already existing in

your gut which results in selective growth of these good bacteria and is linked to various health benefits. The

prebiotic concept was first introduced by Gibson and Roberfroid in 1995 [1] and has been subject to intensive

nutritional research ever since. It is well confirmed by scientists worldwide, including an expert panel under

the umbrella of the International Life Science Institute who concluded in 2010 that “the prebiotic effect exists

and is now a well established scientific fact”. [2, 3] Prebiotic research has continued at a rapid pace with more

than 2000 research articles published over the past five years* (see Figure 1).

Figure 1. Pubmed publications mentioning ‘Prebiotic’

Prebiotics are non-digestible carbohydrates that pass intact through the small intestine and reach the large

intestine undigested. There, they are fermented by bacteria in the saccharolytic fermentation mode (see more

under “Prebiotic fermentation: To the gut and beyond!”), resulting in modifications in the gut microbiota

composition by selective stimulation of the growth of bifidobacteria and lactobacilli; beneficial microorganisms

that are part of the microbiota composition.

*Pubmed search

Publications

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150

200

300

100

400

500

600

700~2000 + articles

5

The most recent scientific definition of prebiotics, elaborated by the International Scientific Association for

Probiotics and Prebiotics in 2008 (6th Meeting, London, Ontario) [4] describes prebiotics as follows:

“A dietary prebiotic is a selectively fermented ingredient that results in specif ic changes in the composition and/or activity of the gastrointestinal microbiota, thus conferring benef it(s) upon host health.”

In order to be classif ied as a prebiotic, certain criteria need to be fulf illed [5]:

• Resistance to hydrolysis and absorption

• Fermented by intestinal microbiota

• Selective stimulation of growth and/or activity of intestinal bacteria associated with health and disease

The scientific substantiation should be based on state-of-the-art techniques on measuring bacterial

counts and should be based on human data. In vitro and animal studies alone do not provide enough

substantiation – human studies are needed.

There are only three proven prebiotics worldwide: chicory root fiber, galacto-oligosaccharide (GOS) and

lactulose which are described in more detail below.

1. Chicory root f iber (synonyms: inulin, shorter chain inulin (= oligofructose = fructo-oligosaccharides (FOS)),

longer chain inulin, mixtures of shorter and longer chain inulin)

• Non-digestible in small intestine and fully fermentable in large intestine

• Made up of oligo- and polysaccharides: inulin-type fructans

• Plant-based natural dietary fiber

• Extracted from the chicory root by hot water

• Extensively researched for more than 20 years; beneficial health effects demonstrated by numerous

human intervention studies

2. Galacto-oligosaccharide (GOS)

• Non-digestible in small intestine

• Qualifies partially as dietary fiber because of non-digestibility (degree of polymerization DP≥3

can be counted as dietary fiber)

• Synthetically produced oligosaccharides of the form Glu α1–4[βGal1-6]n (η=2–5) produced

from lactose (animal origin) by using β-galactosidase

• GOS data base on human intervention studies addressing health benefits is still weak

3. Lactulose

• Disaccharide that is non-digested in small intestine, reaching the large intestine as substrate for microbiota

• As a disaccharide it is not classified as a dietary fiber but as a sugar

• Synthetic disaccharide, produced commercially by isomerization of lactose (animal origin)

• Mostly applied in pharmaceutical industry as a laxative

Some limited data from other non-digestible carbohydrates are available demonstrating some prebiotic

potential in vitro. More research on those “candidates” is needed to demonstrate the effect in human

intervention studies with sufficient statistical power and using state-of-the-art detection methodology.

6

Combination (selected chain length)

Chicory root f iber – a proven prebiotic.

Chicory is a perennial plant of the dandelion family that grows in its wild form in many areas of the country.

The root of the chicory plant stores the carbohydrate energy known as inulin. Inulin is also a storage

carbohydrate in onions, bananas, artichokes, yacon and more. Inulin has been consumed since ancient

times. In the time of ‘gatherers and hunters’ the daily intake was calculated by paleontologists at about

135 g per day. [6] While the chicory root today is no longer a regular part of our diet, its fibers (inulin and its

short-chain form, also called oligofructose) still are and they are used in many fiber-enriched food products.

The chicory plant today is grown by farmers for the mild extraction of inulin from the root by hot water.

Chicory root fiber is an umbrella term for long- and short-chain inulin. The short-chain inulin, aka

oligofructose or fructose-oligosaccharide (FOS) is derived from inulin with an enzyme that naturally also

exists in the chicory root. This process occurs in the mature chicory root. The chain length of inulin may

vary to make it more versatile for different food applications. The degree of polymerization (DP) is used to

describe the chain length. For instance, longer chains (DP≥10) give a more creamy mouthfeel, making it

ideal for fat reduction, while the shorter chains (DP=2–9) give a slightly sweet, clean taste and therefore are

often used for sugar reduction in food products. Dedicated combinations of shorter and longer chain inulin

can also be made.

Inulin OligofructoseChicory roots15–17% Inulin

GFn and Fn

DP=2–60 or more DP=2–9ß (2–1)

Glucose Fructose DP Degree of Polymerization

ß (2–1)

GFn

Partial hydrolysis (enzymatic)

Oligofructose-enriched inulin

Extraction(hot water)

Figure 2. The process from f ield to chicory root f iber

Chicory root f ibers are natural, only extracted from chicory root with pure hot water.

Your microbes at work to keep your gut flora healthy.

7

The prebiotic effect – bif idos as a marker for a healthy microbiota.

Interest in the prebiotic effect on our gut microbiota composition continued to grow which led to numerous

studies in infants, young children and adults. Research applying state-of-the-art techniques confirmed

a selective increase of beneficial bacteria, using bifidobacteria and lactobacilli as well as established

biomarkers, after inulin and oligofructose consumption in human intervention studies.

The following figure demonstrates the totality of chicory root fiber data and their prebiotic effect in adults.

24 human trials were carried out with chicory root fibers showing that inulin and oligofructose selectively

stimulate the growth of bifidobacteria in the large intestine. High levels of bif idobacteria became a marker

for a healthy microbiota composition. [2]

Prebiotics are different to probiotics. Probiotics are currently defined as live microorganisms which, when

administered in adequate amounts, confer a health benefit on the host. The vast majority of all studied and

commercially available probiotics today are bifidobacteria and lactobacilli. There are certain guidelines for

probiotics. They need to survive the gut passage to the large intestine despite the acidity in the stomach.

Each probiotic strain should be clearly characterized which is important for its safety assessment. In addition,

the health benefits need to be established in human studies, specifying the quantity of the microorganism

that leads to the benefit. [7] Probiotics are added to food, often dairy products, or taken as food supplements

to introduce additional amounts of good bacteria into the gut. However, probiotics do not become natural

inhabitants of the large intestine, they are “in transit” and excreted through the feces.

Prebiotics, on the other hand, nourish the good bacteria that are naturally present in the gut as well as

the probiotics and offer a way of selectively stimulating the growth of the good bacteria.

A mixture containing probiotics and prebiotics is called a synbiotic. It is a living organism (probiotic) that is

combined with its preferred ‘food’ (prebiotic) in order to increase the survival rate of the organism in the intestine.

Figure 3. Signif icant increase of bif idobacteria in adults from 5 g/day, inulin and/or oligofructose

*List of references is available upon request inulin/oligofructosecontrol/baseline/placebo

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

10lo

g fe

cal b

ifid

obac

teria

cou

nts

per m

l

Individual studies*

0

4

6

2

8

10

12

8

Microbiota, digestive health and well-being – health benefits linked to chicory root fiber.

Scientists have learned of the importance of a well-functioning colon for our health and well-being.

The colon is responsible for nutrient and water absorption as well as waste secretion and acts as a

mucosal barrier between the external and internal environments. Our gut has its own nervous system.

It’s our “second brain”, regulating peristalsis and the release of digestive enzymes, just to name a few.

The intestine is a significant regulator of our immune system, about two-thirds of all immune cells of

our body are based there. In addition, our colon is the largest hormone producing organ of the body,

e.g. ghrelin, GLP-1, PYY. Its living microorganisms, our microbiota, can produce thousands of different

biologically active substances that may be absorbed and reach organs like the liver, kidneys and also the

brain. In fact, an increased consumption of prebiotics can positively influence the microbes in our gut,

which has implications not only for our gut health but far beyond.

Prebiotic fermentation: “To the gut and beyond!”

Not all dietary fibers are the same. Fermentation of f ibers is the key to many health benef its. Some fibers,

like cellulose are not fermentable, lead to increased bulk in the intestine and are excreted through the

feces. Others, are partly fermentable only. While they are fermented by gut bacteria, they do not necessarily

increase the population of good bacteria, like bifidobacteria. Chicory root fibers, like inulin and oligofructose,

are completely fermented in the colon by gut bacteria and lead to a selective increase in bifidobacteria.

Bifidobacteria and some other bacteria strains break down chicory root fiber by saccharolytic fermentation

which leads to the production of short-chain fatty acids (SCFAs), i.e. acetate, propionate and butyrate. [8, 9]

9

These SCFAs have several beneficial effects, helping to create a more acidic environment in the colon and

therefore enhancing calcium absorption (specifically related to Oligofructose enriched inulin as seen in section

“For stronger bones: Give your bones a treat”), nourishing the intestinal mucosa and inhibiting pathogens.

SCFAs also support the growth of the microbiota, stimulate the peristaltic reflex which results in more frequent

bowel movements and “cross-talk” with the brain to signal satiety. Particularly acetate appears to cross the

blood-brain barrier and reaches the hypothalamus to influence the hunger/satiety center by reducing appetite

and subsequently food intake, as demonstrated in scientific studies done with oligofructose-enriched inulin. [10]

Research in this area is promising and opens up important new possibilities for chicory root fiber to support

healthy nutrition in the light of obesity and diabetes developments. [11] With adequate amounts of prebiotic

chicory root fiber and the related support for the beneficial bacteria (primarily bifidobacteria and lactobacilli),

the more favorable saccharolytic fermentation dominates. In contrast, proteolytic fermentation (protein

fermentation) and the related microbiota which can produce potentially harmful compounds, such as

carcinogens and co-carcinogens is suppressed. Overall we can say that the consumption of chicory root f ibers

and the complete prebiotic fermentation leads to a positive shift in the gut microbiota composition providing

many health benefits. [2, 12]

Figure 4. Prebiotic fermentation – benef its to the gut and beyond

Lung breath

Kidney

Blood

Liver

Large intestine

Nervous system

Immune cells

Hormonal system

Neurotransmitter Serotonin

Cytokines GLP-1, PYY,…urine

Bacterial metabolites SCFAs, othersmicrobiota

Brain

10


Digestive health, a key predictor of well-being.

Digestive health problems, including bowel irregularity and constipation are a common problem in our

society and have far reaching effects on our quality of life and overall health. The consumption and following

fermentation of chicory root f iber can give relief.

Figure 5. Mechanisms that show how chicory root fibers gently increase bowel regularity

The prebiotic fermentation of chicory root fibers by the microbiota leads to break down products (SCFA) and

metabolites which are signals and promote the production of the neurotransmitter serotonin, a key regulator

of the motility of the gastrointestinal tract. [14] This causes the gut peristaltic to “move” and thus supports the

normal gut function that leads to relief. Stool softening occurs as some more water stays in the large intestine

instead of being re-absorbed so that straining can be avoided. The increase in bifidobacterial counts also leads

to an increase in biomass, i.e. an organic and natural increase in fecal bulk and keeps the feces softer. All this

together helps to avoid hard stools and constipation and supports normal bowel function with respect to a

slight but significant increase in stool frequency per week.

In addition to the EFSA evaluation, a meta-analysis of five intervention studies demonstrated significant

effects of inulin on stool frequency, stool consistency and transit time. [15]

chemical stimulation of peristaltic reflex

softer stools

Chicory root fibers are not digestible in small

intestine

bacterial fermentation in large intestine

water bindingcapacity

bowel movement frequency

bacteriawater content of

digesta/fecesgas

productionSCFA

production

intestinal transit time

bowel contentfecal bulk

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Overall, improvement of digestive health by supporting regularity due to chicory root fibers, inulin and

oligofructose, were demonstrated in over 24 human studies ranging from children to older adults (see Figure 6).

It can be concluded that with a daily intake of 8–12 g/day (intake on several occasions during the day),

the positive effect on regularity with chicory root fiber can be achieved.

Figure 6. Effects of chicory root f iber on stool frequency

Kleessen et al. 1997 (IN) – 40 g/d

Scholtens et al. 2006 (OF) – 25–30 g/d

Castiglia-Delavaud et al. 1998 (IN) – 22 g/d


Den Hond et al. 2000 (IN) – 15 g/d

Gibson et al. 1995 (IN) – 15 g/d

Gibson et al. 1995 (OF) – 15 g/d


Grasten et. al. 2003 (IN) – 13 g/d

Micka et al. 2016 (IN) – 12 g/d

Cummings et al. 2001 (OF) – 10 g/d

Brighenti et al. 1999 (IN) – 9 g/d

Menne et al. 2000 (OF) – 8 g/d

Kleessen et al. 2007 (IN) – 7.5 g/d

Bouhnik et al. 2007 (IN) – 5 g/d

Kolida et al. 2007 (IN) – 5 g/d

Alles et al. 1996 (OF) – 5 g/d

*significant effect vs. placebo/control (p<0.05)

Improvement

10 30 50 70 90 110

Change in stool frequency vs. placebo/control [%]

vs. wheat pentosan

vs. lactose

vs. lactose

*

*

*

*

*

Isakov et al. 2013 (IN) – 3 g/d

gut health

well- being

12


As mentioned before, the large intestine is the place where two-thirds of all immune cells are based.

For this reason, researchers assume a close link between bifidobacteria and the support of inner resistance.

The fermentation of chicory root fiber creates a more acidic environment in the large intestine keeping

acid-sensitive pathogens at bay, nourishing mucosa cells, thickening the mucous layer and maintaining

an intact gut barrier. [16] Cummings demonstrated in his study design that those at risk of developing travelers’

diarrhea may benefit from oligofructose consumption. Healthy subjects at risk of travelers’ diarrhea were

given 10 g of oligofructose per day. They experienced a small significant increase in stool frequency,

a (non-significant) decrease in diarrhea episodes and a significantly improved sense of well-being. [17]

What about FODMAP in IBS patients?

FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols” that

are poorly absorbed short-chain carbohydrates, such as, GOS, FOS, lactose, fructose, sugar alcohols like

sorbitol and many other non-digestible carbohydrates in fruits and vegetables. It is a restrictive diet that

basically leads to the exclusion of fruits and vegetables from the diet. FODMAP components are fermented

by the microbiota and this process is believed to be the cause of gastrointestinal complaints, i.e. bloating,

gas, diarrhea, constipation and cramping in sensitive patients. A diet low in “FODMAP” compounds is

therefore often recommended for patients that feel to be affected, especially those with irritable bowel

syndrome (IBS).

As is the case for any extreme diet, pros and cons need to be looked at and at the same time the scientific

proof for the underlying hypotheses needs to be provided. A lot of questions pop up in this case. Without

proper monitoring by a dietitian, a low FODMAP diet can be unbalanced, limiting fiber intake and

consumption of fruits and vegetables – this leads to unhealthy nutrition. Only if the subjective feeling of

well-being is significantly improving and gastrointestinal complaints disappear on long-term, could this

special nutrition be a compromise for affected patients.

The saccharolytic fermentation is the preferred pathway to support health. The absence of saccharolytic

fermentation triggered by the low FODMAP diet could cause more harm than good. There is often a belief

that the production of SCFA and the production of hydrogen and carbon dioxide, that may occur depending

on the bacterial composition, lead to subjective unacceptable gastrointestinal complaints. Bifidobacteria are

SCFA producers, but not gas producers – unlike some other bacteria. However, a vast majority of the SCFA

and gases are absorbed in the intestine and metabolized or excreted via the breath. The body can handle this

very well, even in sensitive people. In fact, scientific evidence has shown that (soluble) fibers help reduce

global symptoms of IBS and abdominal pain. [18–20] It is questionable if the scientific basis is strong enough to

conclude beneficial effects of low FODMAP diets in IBS patients. [21] Current data shows that at least chicory

root f iber is well-tolerated by IBS patients at normal daily intakes. [22, 23]

As a proven prebiotic, chicory root fiber contributes to support a healthy gut environment and relieves

constipation in some IBS patients due to improved bowel regularity and therefore supports a healthy human

gut microbiota. To conclude, at the end of the day, what counts is the patient’s feeling of well-being.

13

Feeling the digestion is OK!

In most societies around the world, including the United States, only about half of the dietary fiber that

should be eaten is indeed consumed. In order to bridge the fiber gap, a higher fiber intake is needed and

recommended as seen in the recently issued Dietary Guidelines for Americans 2015–2020. [24] A higher

intake of fiber leads to more activity in the gut, you can feel that “something is happening”, e.g. from an

increase in bowel movements per week, softer stools (but no diarrhea) or possibly slightly more gas

production compared to a diet with less fiber intake. Feeling your gut work is normal and the reason why

we increase our fiber consumption in our diet. As health care professionals, it is important to bring this

healthy body perception back to the consumer. Our gut is not “lazy and silent” anymore but actively

working and fermenting the fibers, creating all the health benefits we get from fiber. Everyone’s experience

is different and therefore, fiber intake should be individually adjusted. We should increase fiber intake

gradually to give our microbiota time to adjust.

Chicory root f iber inf luences the path towards a healthy body weight.

The prevalence of overweight and obesity has become a leading health concern worldwide, reaching

epidemic levels. Supporting weight loss and avoiding weight gain is equally important. One of the

strategies to support weight management focuses on the development of healthier food choices.

Besides the benefits on digestive health as just illustrated, chicory root fiber has gained more and

14


more attention regarding their supporting role in helping to eat less, naturally. Chicory root fiber has

supporting scientific evidence in animal and human intervention studies on all stages of the scientific

“ladder to success” in the weight management approach (see Figure 7.).

Figure 7. Chicory root f iber inf luences body weight

The mechanism behind this is related to the prebiotic fermentation of chicory root fiber in the colon and

the subsequent formation of SCFAs (acetate, propionate, butyrate and lactate). These SCFAs influence

appetite regulation and food intake by triggering a release of the gut hormones like GLP-1 and PYY. Both

hormones are secreted (by L-cells) at the end of the small intestine and in the large intestine. They stimulate

glucose-dependent insulin secretion, inhibit glucagon release in the pancreas and gastric emptying in the

stomach as well as directly suppress appetite in the brain. [10, 28, 29]

Further research on human data suggests that chicory root f iber intake helps you to eat less calories naturally.

A systematic review of 26 intervention studies confirms an increased self-reported feeling of satiety after

chicory root fiber supplementation. [30] Results from an isocaloric study in ten healthy (normal to slightly

overweight) adults show that people consumed about 5% less calories with 16 g of oligofructose added to

their diet compared to the control group. [31]

These effects were confirmed in a study from Parnell and Reimer where 21 g of oligofructose per day was

given to 48 healthy, overweight adults for three months. As a consequence, the oligofructose group had a

significantly reduced energy intake and lost body weight while the control group gained weight. Weight loss

was primarily associated with reduction of trunk fat mass. The study participants receiving the oligofructose

supplementation also experienced suppressed ghrelin and higher PYY levels increasing the satiety feeling. [32]

Weight Loss

Subjective Appetite Ratings

Satiety Regulation (Hormones)

Energy Intake

Body Weight / Body Composition

Overweight Prevention

Avoiding weight gain and losing weight in case of overweight are equally important

15

Patterned bars represent supportive evidence from self-reported data or discontinued fiber intake

Dosage (g/d)

oligofructose-enriched inulinOrafti® P95Other OFInulin

-20-25 -15 -10 -5 0 5

Lower energy intake [%]

**

*

*

**

*

*

*

**

**

Less energy intake with

12 g/d oligofructose-enriched inulin 16 g/d

Orafti® P95

10 g/d

10 g/d

10 g/d

55 g/d

30 g/d

21 g/d

16 g/d

12 g/d

30 g/d

30 g/d

16 g/d

15 g/d

15 g/d

12 g/d

12 g/d

35 g/d

10 g/d

15 g/d

8 g/d

16 g/d

Beneficial effects of chicory root fiber supplementation on body weight and body composition were also

confirmed by the group of Prof. Reimer in Canadian overweight and obese children and U.S. adolescents

during growth. In a double-blind, randomized parallel study, 42 overweight and obese children, 7–12 years

old, consumed 8 g of oligofructose-enriched inulin (a dedicated 50/50 combination of shorter and longer

chain inulin) per day for 16 weeks. The results showed that subjective ratings of appetite and fullness

improved, ad libitum energy intake at a breakfast buffet occasion dropped by about 200 calories (significant

in the older age group 11–12 years), BMI and body fat mass decreased, IL-6 (a marker for overweight- and

obesity-related inflammation) dropped significantly and the fecal flora composition significantly increased

counts of bifidobacteria. [33] Based on Prof. Raylene Reimer’s research, she concluded that:

“The intake of [BENEO’s] prebiotic f iber … [is] one more tool to use in the obesity epidemic.”

The bar chart below illustrates the published studies on the effects of chicory root fibers on energy intake. Energy

intake (caloric intake) is a strong parameter when assessing the strength of the data for weight management

support. It is stronger than subjective appetite ratings and stronger than measurements of hormonal changes

although those two elements are important “steps” on the ladder of weight management (see Figure 7).

Figure 8. Chicory root f ibers reduce energy intake in adults

Chicory root f ibers help people eat less over time.

1)

1)

1) Data not reported in % energy intake change

*p<0.05**p<0.01

16

Bringing your blood sugar under control.

Diabetes has become a global health problem with an increasing prevalence year after year. In the U.S.,

29.3 million people are diagnosed with diabetes, almost 10% of the population. [34] In 2012, 86 million

American adults had prediabetes, more than 1 out of 3. [35]

Chicory root fiber intake results in a significantly lower blood sugar and insulin response while increasing the

fiber content without compromising the taste. These effects were confirmed at a 20% sugar replacement as the

lowest measured dose. EFSA evaluated the data which resulted in a positive opinion and an approved health

claim in May 2016 on the reduction of postprandial glycemic response from non-digestible carbohydrates,

like chicory root fiber. [36] Furthermore, studies with oligofructose-enriched inulin supplementation

demonstrated that body weight, insulin sensitivity and glucose homeostasis were improved in pre-diabetic

subjects consuming 30 g of oligofructose-enriched inulin per day for six weeks. The results were independent

of lifestyle and not seen in the control group who ingested cellulose instead of inulin. To emphasize again,

the prebiotic fermentation due to chicory root fiber and its influence on GLP-1 as a regulating gut

hormone is regarded as the key benefit in the context of blood sugar management support. oligofructose-enriched inulin resulted in a beneficial enhancement of early-phase insulin secretion in response to a meal,

which is considered to be of particular relevance for people at risk of developing type 2 diabetes mellitus. [37, 38]

A systematic review of 26 intervention studies showed that prebiotic supplementation with chicory root fibers

significantly reduced postprandial glucose and insulin concentrations. [30]

These data encourage the use of chicory root fibers as an approach to reduce blood glucose and insulin

levels in the diet of people wanting to improve the blood glucose response in prevention and management of

glucose tolerance impairments.

For stronger bones: Give your bones a treat.

Osteoporosis is a chronic and progressive disease leading to low bone mass, reduced bone density and

reduced bone quality with a consequently higher risk of fracture. It is the second leading health care problem

after cardiovascular diseases according to the World Health Organisation (WHO). Approximately 200 million

people suffer from osteoporosis worldwide. In the U.S., around 54 million adults age 50 and older are

affected by osteoporosis and low bone mass. [39] Sufficient calcium intake and absorption is the key to prevent

osteoporosis. Since only about 30% of the dietary calcium is absorbed in the body, it is even more important

to make the best use of all the calcium which is available in our diet. Our body builds bone mass during

childhood into the mid-twenties where the peak bone mass is reached. After that, bone mass decreases with

an even faster demineralization process in women after menopause. It is therefore important to maximize

peak bone mass during adolescence in order to reduce bone loss later in life.

More than twelve human intervention studies have illustrated that chicory root f iber increases calcium

absorption. The unique combination of longer chain inulin and shorter chain inulin (oligofructose/FOS),

aka oligofructose-enriched inulin, has been shown to change the environment of the whole length of the

large intestine so that the complete large intestine environment is influenced to promote calcium

absorption, i.e. a new place of absorption in addition to the small intestine was made available due to this

and the bioavailability of


17

calcium in the normal diet is significantly increased. The mechanism behind is that SCFAs that are produced

from chicory root fiber fermentation increase calcium absorption by decreasing the pH in the colon, stimulating

growth of mucosal cells to increase the absorptive surface, enhancing intracellular permeability and indirectly

stimulating the production of calcium-binding proteins. [40] These beneficial effects of oligofructose-enriched inulin have been demonstrated irrespective of food matrix and have no negative effect on other

minerals and vitamin D levels.

A one year intervention study, conducted at the USDA Children’s Nutrition Research Center at the Baylor College

of Medicine in Houston, TX supplied 8 g of oligofructose-enriched inulin per day to 100 adolescents to

examine long-term effects of chicory root fiber on calcium absorption and bone health. After one year, the

oligofructose-enriched inulin group had significantly higher calcium absorption and greater bone mineral

density (BMD) compared to the control group, i.e. it was demonstrated that the additional calcium absorbed

indeed reached the bones. This study is one of a kind in demonstrating long-term benefits of oligofructose-enriched inulin for bone health. [41] Results on true calcium absorption and BMD are shown in the figures

below.

Figure 9. True Ca absorption after oligofructose-enriched inulin intake

Control

Synergy1

True

Ca

abso

rptio

n [%

]C

hang

e in

who

le-b

ody

BM

D [g

/cm

2 ]

baseline

Control

***

**

*

8 weeks

Synergy1

1 year20

0.015

22

0.02

24

0.025

26

0.03

28

0.035

30

0.04

32

0.045

34

36

38

40

0.05

*p < 0.05 vs. control, ***p < 0.001 vs. control

Figure 10. Changes in whole-body bone mineral density (BMD) after supplementation

with oligofructose-enriched inulin

**p = 0.01 vs. control

18

The development of the gut microbiota is a critical and essential process early in life as it may impact

later health outcomes by potentially reducing the risk of obesity, inflammatory bowel disease, allergies

and certain behavioral disorders in adulthood. [42]

Importance of early colonization.

Babies are born with an (almost) sterile gastrointestinal tract which is quickly colonized by microorganisms

after birth. Important factors that affect bacterial colonization are the mode of delivery, prematurity, excessive

use of antibiotics during the perinatal period, mother’s microbiota and type of feeding (breastfeeding). Around

the age of 2–3 years, the microbiota composition becomes more stable and begins to resemble that of an adult.

Bifidobacteria are the dominating microorganisms in the gut microbiota of breastfed infants independent

of the region they were born. High levels of bifidobacteria in breastfed infants have been associated with

reduced counts of potentially harmful bacteria like E. coli and others. Human milk oligosaccharides (HMOs)

are the first prebiotics in the diet of a baby. They are a complex group of more than 200 identified non-digestible

What about the little ones? Benefits of chicory root fiber intake in infants and small children.

19

oligo- and polysaccharides found in human breast milk and are also described as the “bifidofactor” of

human breast milk. They greatly influence the infant’s microbiota composition. Breastfeeding is the best

nutrition for babies and associated with a protective role in the development of a number of diseases later

in life. When breastfeeding is not possible, the baby should nevertheless get as close as possible to the

advantages of breastfeeding. This is the reason why inulin and oligofructose are part of infant and follow-on

formulas around the world.

Figure 11 reflects the impressive amount of 14 human intervention studies with infants and small children

that demonstrate that supplementing infant formulas or follow-on formulas with chicory root fibers

(oligo fructose/FOS, long-chain inulin, mixtures of shorter and longer chain inulin including oligofructose-enriched inulin were used in those studies) increase the amount of bifidobacteria which positively affects

the infant’s microbiota and brings it closer to that of breastfed babies.

Figure 11. Prebiotic data with chicory root fibers in infants and small children

*List of references is available upon request

A study conducted in Belgium analyzed the influence of chicory root fiber on the gut microbiota composition

of 62 healthy infants. The babies received four different supplemented formulas for 28 days. The numbers of

bifidobacteria significantly increased in the group with chicory root fiber addition (oligofructose-enriched inulin, a

prebiotic mix of inulin and oligofructose) and were comparable to that of breastfed infants compared to the

control group. [43]

1 2 3 4 5 6 7 8Studies

Popu

latio

n

9 10 11 12 13 14

Bifi

doba

cter

ia c

ount

s (lo

g10

cfu/

g fe

ces)

0

4

6

2

8

10

14

12Control

IN/OF

0 – 6 months 6 months – 2 years

* * * ** * *

*

*

20

What about the little ones? Benefits of chicory root fiber intake in infants and small children.

Closa-Monasterolo et al. led a study to address the prebiotic effect as well as safety of chicory root fibers in

newborns. 252 healthy infants received a formula enriched with oligofructose-enriched inulin or a control formula

for the first four months of life. The results showed a higher increase of bifidobacteria in the oligofructose-enriched inulin group versus infants fed the control formula. The microbiota composition of the oligofructose-enriched inulin infants was comparable to that of breastfed infants. Also, all infants experienced normal growth

and development patterns. Tolerance and formula acceptance was very good confirming the safety of the

oligofructose-enriched inulin-containing formula. [44]

Dr. Closa-Monasterolo concludes:

“A 0.8 g/dL oligofructose-enriched inulin-supplemented infant formula during the f irst four months of life is safe and effective, promoting a gut microbiota closer to that of breastfeeding.”

Healthy bowel habit, more important than ever.

One of the main concerns of mothers is their baby’s stools as this is related to their overall health and well-

being. There are many things that can affect an infant’s bowel movement, such as nutrition, age

and different feeding habits. There is a major difference in stool frequency and consistency of breastfed

compared to formula fed infants. Breastfed babies have more frequent and softer stools, often even liquid

stools because of the HMOs in breast milk. Concentration of HMO in mature breast milk is reported to be

at approximately 12 – 14g/L [45, 46], in the breast milk of the first days concentrations of 20 – 24g/L are

reported. Formula fed babies have often harder stools and constipation is an issue. In order to promote

a healthy bowel habit, also for milk-based formula eating babies, prebiotics are added to infant formulas to

get closer to a breastfed situation. Supplementing formulas with inulin and oligofructose from chicory root

have been shown to benefit by providing soft but not liquid stools.

The four week study led by Veereman-Wauters et al. on newborns illustrated significantly softer stool

consistency when adding oligofructose-enriched inulin to the formula versus the control group. Overall,

breastfed babies had the softest stools while the control group experienced the hardest bowels. No impact

was shown on stool frequency. [43]

In the study conducted in Spain by Closa-Monasterolo et al., healthy infants receiving a formula enriched

with oligofructose-enriched inulin had significantly higher stool frequency and softer stools compared to

controls, moving them closer to infants that were breastfed. In addition, the microbiota composition of

the

oligofructose-enriched inulin infant group was closer to that of the breastfed babies, clearly demonstrating

the safety and effectiveness of a formula supplemented with oligofructose-enriched inulin. [44]

One of the most common gastrointestinal complaints in children is chronic constipation. BENEO therefore

conducted a pilot study in 17 constipated children (2–5 years old) to investigate the effects of chicory root

fiber supplementation on bowel regularity in this group of children. Those who received the prebiotics had

significantly softer stools compared to the control group. [47]

21

naturallysourced

Increased inner protection.

The time period right after birth is important for programming the immune system. With regards to this, nutri-

tion during pregnancy and during early postnatal life plays an important role. In addition, the newborn has an

immature immune system that increases its susceptibility to infections. This vulnerability is even more important

in formula fed infants. A balanced gut microbiota composition with increased levels of bifidobacteria seems

to benefit the immunity of infants. Since higher levels of bifidobacteria are found in breastfed infants, a similar

microbial colonization should be encouraged for formular-fed infants. Adding prebiotics to the formula is a step

in the right direction.

Through their effect on the growth of bifidobacteria, thereby resembling the benefits of breastfeeding on the

maturation of the immune system, prebiotics may offer additional protection and strengthen the mucosal barrier

that can be essential for a newborn’s immune system, in particular if formula fed.

A six month study conducted on 123 healthy children (4–24 months old) in day care centers focused on the

effect of oligofructose-enriched cereals on gastrointestinal markers related to health and well-being. The babies

in the oligofructose group experienced less general gastrointestinal symptoms, like vomiting, regurgitation and

general discomfort compared to the control group. Oligofructose supplementation also showed statistically

significant reduced symptoms associated with diarrhea, such as fever and physician visits. The control group

had a greater absence from day care centers and a higher usage of antibiotics compared to children receiving

the prebiotic supplementation. [48]

A review and meta-analysis of five randomized controlled trials assessed the effects of prebiotics (including

oligofructose) in the prevention of acute infectious diseases in 0–24 months old babies. The results showed

that the number of infectious diseases requiring antibiotic therapy decreased with supplementation of prebiotics.

From studies available to date, we can assume that prebiotics may be effective in reducing the rate of overall

infections in infants and children aged 0–24 months. [49]

22

Dietary fiber remains a nutrient of concern, according to the Report on the Dietary Guidelines

for Americans 2015–2020, as we all do not eat enough fiber. We only consume about half of

the dietary fiber we should be eating, [24–27] (see Figure 12).

.

We need to find new ways to increase the fiber intake in our diet, since people have their limits when eating

fruits and vegetables – we can only eat so much. A mix of additional fibers is needed; fibers with the scientific

proof of health benefits associated with their intake. Chicory root fibers help bridge the fiber gap by enriching

consumer products with fiber, still letting them taste good and providing additional metabolic benefits. Both,

the sensory and physiological components of chicory root fiber create healthy fiber-rich food products that can

be found in grocery stores. In addition to the fiber enrichment, inulin with its longer chain structure provides

a creamy mouthfeel and helps to substitute fat in products. Short-chain inulin (oligofructose/FOS) provides

a slightly sweet taste and helps to achieve sugar reduction by fiber enrichment with no compromise in taste.

In addition to getting fiber from whole foods, like fruits, vegetables and whole grains, chicory root

f iber-enriched food products are an excellent choice to help fulf ill the f iber recommendation in our diet.

Concluding remarks

Figure 12. Fiber recommendation vs. actual intake in the U.S. and Canada

Canada

Canada

USA

USA

0

0

20

2010

40

30

Dietary f iber in g/day (male)

Dietary f iber in g/day (female)

Recommendation

Estimated Intake

Recommendation

Estimated Intake

38

32

25

27

17

18

14

16

23

Chicory root f ibers, i.e. inulin, oligofructose/FOS, long-chain inulin, mixtures of shorter

and longer chain inulin, support your microbiota, your digestive health and beyond!

Chicory root f ibers

• are naturally and gently extracted from the chicory root

• feed the good bacteria inside you which is important for health and well-being

• have the strongest scientific prebiotic data with 24 human intervention studies

• are clinically proven prebiotics

• improve bowel habit and gently maintain bowel regularity

• have prebiotic benefits that go beyond gut health

• help you eat less naturally

• lower blood glucose response and insulin response

• improve calcium absorption for bone health support

• support the immune system (emerging growing science)

• are safe to eat for all age-groups and well-tolerated

As health care professionals we need to recommend consuming more fibers that show proof of

health benefits. More and more research illustrates that the influence of fiber – like chicory root f iber –

on our microbiota has benefits that go beyond digestive health. Keep your eyes open for more exciting

new science on this topic!

24

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